Journal of Anesthesiology

2015; 3(6): 25-29

http://www.sciencepublishinggroup.com/j/ja
doi: 10.11648/j.ja.20150306.11
ISSN: 2376-7766(Print); ISSN: 2376-7774(Online)

Observation on Clinical Effects of Postoperative Analgesia

with Sufentanil After Upper and Lower Abdominal Surgery:
A Prospective Study
Soriba Naby Camara1, Oumar Taibata Balde2, Ahmed Boubacar Barry2, Ibrahima Sory Souare3,
Sadamoudou Traore4, Naby Laye Moussa Keita5, Aboubacar Sylla5, Foulematou Soumah6,
Diowen Goviden6, Aboubacar Toure7, Fode Abass Cisse8, Amara Cisse8, Salifou Camara9,
Mamadou Traore9, Mohamed Kerfalla Camara9, Fode Mohamed Sylla9, Sneha Ballah10
1
Department of Pancreatic Surgery, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
2
Department of Visceral Surgery, National Hospital of Donka, University Gamal Abdel Nasser of Conakry, Conakry, Guinea
3
Department of Neurosurgery, Friendship Hospital Sino Guinea, University Gamal Abdel Nasser of Conakry, Conakry Guinea
4
Department of Medical Imaging, Good Shepherd Medical Center, Longview, Texas
5
Department of Biochemistry, University Gamal Abdel Nasser of Conakry, Conakry Guinea
6
Department of Anesthesia, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China
7
Depatment of General Surgery, National Hospital of Ignace Deen, University Gamal Abdel Nasser of Conakry, Conakry, Guinea
8
Department of Neurology, National Hospital of Ignace Deen, University Gamal Abdel Nasser of Conakry, Conakry, Guinea
9
Department of Pharmacy, University Gamal Abdel Nasser of Conakry, Conakry Guinea
10
Department of Internal Medicine Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

Email address:
csoribanaby@yahoo.com (S. N. Camara)

To cite this article:

Soriba Naby Camara, Oumar Taibata Balde, Ahmed Boubacar Barry, Ibrahima Sory Souare, Sadamoudou Traore, Naby Laye Moussa Keita,
Aboubacar Sylla, Foulematou Soumah, Diowen Goviden, Aboubacar Toure, Fode Abass Cisse, Amara Cisse, Salifou Camara, Mamadou
Traore, Mohamed Kerfalla Camara, Fode Mohamed Sylla, Sneha Ballah. Observation on Clinical Effects of Postoperative Analgesia with
Sufentanil After Upper and Lower Abdominal Surgery: A Prospective Study. Journal of Anesthesiology. Vol. 3, No. 6, 2015, pp. 25-29.
doi: 10.11648/j.ja.20150306.11

Received: February 12, 2016; Accepted: May 14, 2016; Published: June 8, 2016

Abstract: Post-operative analgesia is crucial to facilitate early ambulation, prevent complications, increase patient
satisfaction while ensuring a faster recovery pace. Opioid analgesics have been recognized as the mainstay for treatment of
acute pain in a majority of postoperative care units. Intravenous patient-controlled analgesia (IVPCA) with the opioids drugs
sufentanil and fentanyl has proven to be effective when used in the immediate postoperative period. The aim of the study was
to determine the efficacy and safety of sufentanil for postoperative analgesia based on the same principle, and, fentanyl citrate
was chosen as a control drug for upper and lower abdominal operations under general anesthesia. Methodology; It was a
prospective clinical study carried out at Union hospital, from December 2014 to March 2015. 240 patients were scheduled for
upper and lower abdominal surgery requiring general anesthesia. They were divided into four groups: test group (A) and
control group (B); (C) and (D), and are given fentanyl and sufentanil by IVPCA for postoperative analgesia relief following
surgery. Pain was assessed by the visual analogue Scale. The determined pain relief; pulse rate, BP, ECG, sedation score,
SPO2, pruritus score, nausea score and vomiting score were all recorded for each patient. Results The pressing times values
show that fentanyl (A) and high dose sufentanil (C, D) both provided a satisfactory level of analgesia. Moreover, VAS scores
of the patients on high dose sufentanil (C, D) were lower, implying superior analgesic effects at these doses. However, low
dose sufentanil (B) may only provide limited and inadequate analgesia. The degree of pruritus was less marked in patients on
sufentanil than those on fentanyl as demonstrated by the lower Pruritus scores in sufentanil groups (B, C, D). Low dose
sufentanil and fentanyl have shown to have similar extent of side effects overall. Conclusion It was found that sufentanil had
superior analgesic effect to that of fentanyl in patients who had undergone open abdominal surgery. The extent of the
26 Soriba Naby Camara et al.: Observation on Clinical Effects of Postoperative Analgesia with Sufentanil After
Upper and Lower Abdominal Surgery: A Prospective Study
occurrence of adverse reactions to light in the low-dose sufentanil group (B) is less than that in the high-dose groups (C, D),
the concentration of persistent postoperative analgesia sufentanil should reach 0.02µg / (kg ml), and the flow rate maintained at
2ml / h.
Keywords: Sufentanil, Pain, Analgesia Postoperative, IVPCA, General Anesthesia, Upper Surgery, Low Surgery,
Wuhan Union Hospital
1. Introduction
Management of acute pain in the intensive care requires
emphasis to be laid on achieving satisfactory analgesia with
drugs which can suppress pain which is otherwise resistant to
conventional analgesics and nonsteroidal anti inflammatory
drugs. Morphine is the most commonly used analgesic for
providing immediate postoperative pain relief owing to its
rapid transport to target tissues after intravenous injection,
and, it also exhibits hydrophobic properties thus allowing it
to provide analgesia for longer period. However, sufentanil
may be preferred over morphine because of its even faster
onset of action and shorter duration of action, without
exhibiting the side effects of the longer-acting morphine on
the system. [1, 2].
In 1979, the International Association for the study of pain
(IASP) published the definition of pain as “an unpleasant
sensory and emotional experience associated with actual or
potential tissue damage, or described in terms of such
damage”. [2, 3]
Acute pain is often due to nociceptive stimuli such as
injury, organ dysfunction or disease; the surgery can be
assimilated to an injury. [4, 7]
Pain acts as an alarm system to help locate the site of
injury and sometimes the cause of an aggression (burning,
cramping, and cut). There are 2 types of nociceptive pain
visceral pain and somatic pain.
Clinically the consequences of pain on mortality and
morbidity are high particularly due to severe pain and the
neuroendocrine stress response that follows. Surgical stress
can cause tachycardia, increased resistance to systemic
circulation and tension. This implies an increase in cardiac
work and its need for oxygen therefore being troublesome
for patients suffering from coronary heart disease or
pericardial disease.
Furthermore, respiratory system will have to increase its
activity in order to meet the demand of oxygen. However,
this function may be compromised if pulmonary disease is
present. Hormonal response induced by pain causes an
increase of catecholamine, glucagon and cortical, and a
decrease of insulin and testosterone. The increased glucagon
and insulin decreased in some patients who undergo a major
stress explains the decompensated diabetic mellitus. The
cortical stimulate the renin- angiotensin-aldosterone system
(RAAS) causing water and salt retention. Increased platelet
adhesion and leukocytosis combined with lymphopenia are
responsible for the production of a hypercoagulable state due
to hematological stress [8, 9, 10].
Our framework is based on the sympathetic hyperactivity
in abdominal surgery and also the impacts on the smooth
muscles. Urine retention and ileus reflux characterized by
nausea and vomiting are noted along with stress gastritis
increased gastric acid secretion. Eventually, pain can be a
major threat to the patient's mental state resulting in
depression, anxiousness and aggression [9, 11].
Thence, the management of postoperative analgesia pain is
paramount. The management of postoperative pain depends
on the patient's antecedents, surgery, anesthesia and socio-
cultural factors. [11, 12]. Post-operative pain management
involves the use of analgesics such as sufentanil.
The assessment of postoperative pain is challenging,
particularly to know the pain intensity. The mostly used
measurement is the visual analogue scale (VAS) which
evaluate the pain intensity on the scale of 0 (no pain) to 10 or
100 (severe and intense pain). [10, 13]
2. Methods
2.1. Type and Period of Study
This study was a prospective clinical study carried out at
Union hospital from January 2014 to May 2015. 240
patients who were scheduled for upper and lower
abdominal surgery and requiring general anesthesia. The
patients’ (both male and female) age ranged from 18 to 65
years old with ASA I-II (American Society of
Anesthesiology). Surgery duration was estimated to be
between 1.5 to 4 hours. Patients were informed to sign an
agreement in order to conduct the study.
2.2. Inclusion Criteria
Patient aged more than 30 years or older-programmed for
upper or lower abdominal surgery and do not have any
history of chronic respiratory, renal or hepatic insufficiency.
2.3. Exclusion Criteria
Exclusion criteria consisted of: Patients with ASA grade
≥III and who participated in other clinical trials 4 weeks prior
to the start of the study, patients with a history of poorly-
controlled hypertension, pregnancy or lactating female,
patients with neurological and psychiatric disorders, severe
alcoholism, history of prolonged high doses of sedatives,
patients not aged between 18 to 30 years old, patients with
known allergy to non-steroidal anti-inflammatory (NSAIDs)
and patients with existing heart disease.
 Journal of Anesthesiology 2015; 3(6): 25-29 27

2.4. Anesthesia Assessment Table 1. Sedation score (RAMSAY).

Consent forms were collected from patients before
proceeding with anesthesia. All patients received the pre-
anesthetists check-up including a detailed systemic
examination and general examination. Preoperative blood
pressure, pulse, respiratory rate and oxygen saturation were
recorded.
Anesthesia Induction
Induction of anesthesia was done intravenously by
administration of an opiate (fentanyl) at a dose of 2-4 µg / kg,
a barbiturate (propofol) of 1.5-2mg / kg, a neuromuscular
Blocker (rocuronium) 0.6 mg / kg or (vecuronium) 0.1mg /
kg and a benzodiazepine (midazolam) of 1-2mg and finally a
rapid intubation was given. All routine investigation like
hemoglobin, random blood sugar, serum creatinine, urine
routine, blood urea and microscopy examination, clotting
time and bleeding time were carried out during the time of
induction. All the patients needed pure oxygen. Supplemental
Remifentanil and propofol were pumped intravenously by
1% to 3% and sufentanil were given by 0.25µg/kg.
The general anesthesia was maintained with sevoflurane
inhalation which is an agent whose minimum alveolar
concentration (MAC) is 2, and rocurium or vecuronium bolus
for muscle relaxation.
Furthermore, the patients were randomly allocated into 4
groups for postoperative analgesic treatment. Fentanyl
(2.5µg/kg) was administered intravenously in control group
A (n=60) just 1 hour before the end of the surgery and was
maintained with 0.2 µg/ (kg.ml) postoperatively. In group B
(n=60), C (n=60) and D (n=60), sufentanil was administered
1 hour before the surgery ends with a dose of 0.25 and was
maintained postoperatively with 0.0175 µg/ (kg.ml), 0.02 µg/
(kg.ml), .0225 µg/ (kg.ml) respectively.
2.5. Postoperative Analgesia Assessment
At thirty minutes post-surgery, the patients were connected
to an analgesia pump of 120ml total capacity, with a flow rate
2 ml/h, bolus 0.5ml, interval of 15mins and PCA of 48 hours.
General information was recorded such as, sex, age, weight,
height, physical examination, medical history, drug allergies,
co-morbidities and medication history. Effectiveness
outcome measures observed indicators, each with a score, at
every follow-up point; PCA: patient effective, ineffective
press time, dose; VAS Score and the vital signs: SPO2,
respiratory rate, pulse rate, BP, pruritus score, sedation score
(RAMSAY) and complication if any were assessed after
administration of drug.
Table 4. Nausea Score.
SCORE RESPONSE
1 Patient awake and anxious, agitated or restless
2 patient awake and cooperative, oriented, tranquil
3 Patient asleep, responsive to commands
4 Patient asleep with brisk to stimulus (light and noise)
5 Patient asleep with response to pain only
Table 2. Vomiting score.
SCORE RESPONSE
0 No vomiting
1 Mild vomiting, 1-2times /24h
2 Moderate vomiting, 3-5times /24h
3 Severe vomiting > 5times /24h
Table 3. Pruritus score.
SCORE RESPONSE
0 No itching
1 Mild itching
2 Severe itching
2.6. Statiscal Analysis
All statistical analyzes were performed using (SAS)
statistical analytic software to complete professional.
Parametric statistical test were used wherever possible
methods or models. The test, the control group and the test
group. P ≤ 0.05 considered the establishment of superiorly.
Other statistical tests all indicators are used two-sided test, P
≤ 0.05 differences will be considered statistically significant
test.
3. Results
Patients (n=240) both female and male with a ASA grade
I-II were admitted for lower and upper abdominal surgery
with their age ranging from 18 to 65 years old in Union
Hospital in the year 2014-2015. The patients were divided
postoperatively into 4 groups namely A, B, C, D, A being the
control group receiving injection fentanyl and B, C, D group
receiving injection sufentanil.
Out of 240 cases, only 184 completed the test. The number
of cases in each group was as follows; group A; 42, group B;
41, group C; 51, and group D; 50.
Evaluation
Compared with group A, there was no statistical difference
in the group B, group C and D, as the point in the time at
each visit pressing times.

Follow-up Point A with B A with C A with D A with D A with C A with B

1h 0.7347 0.2438 0.1211 0.3415 0.1795 0.6621
2h 0.0116 0.0082 0.0264 0.9361 0.7308 0.6649
4h 0.0935 0.0002 0.0263 0.0557 0.6085 0.1537
8h 0.0095 0.0003 0.0011 0.2414 0.4268 0.6978
12h 0.0034 <0.0001 0.0012 0.1676 0.7396 0.2902
24h 0.0010 0.0006 0.0002 0.9570 0.7433 0.7793
48h 0.0001 <0.0001 <0.0001 0.7136 0.7426 0.9837
28 Soriba Naby Camara et al.: Observation on Clinical Effects of Postoperative Analgesia with Sufentanil After
Upper and Lower Abdominal Surgery: A Prospective Study

In each follop-up point there was no statistically significance difference for Ramsay sedation score among all the four
groups (Table 5).
The nausea scores groups B, C and D after 2h, 8h, 12h, 24h and 48h were less compared to group A except after 4h.
Evaluation

Table 5. Pruritus Score.

Follow-up Point A with B A with C A with D B with C B With D C with D

1h 0.5564 0.2345 0.3874 0.4879 0.7528 0.7028
2h 0.2931 0.4611 0.0479 0.7807 0.2596 0.2081
4h 0.1101 0.0642 0.0344 0.7666 0.5350 0.7443
8h 0.0609 0.0619 0.1215 0.9958 0.7275 0.7316
12h 0.0152 0.0332 0.1136 0.7011 0.3089 0.5196
24h 0.0506 0.0750 0.0215 0.7905 0.7916 0.5682
48h 0.0175 0.0179 0.0088 0.9953 0.7485 0.7443

Table 6. Distribution of patients according to the pressing times.

Parameter/time A and B A and C A and D B and C B and D C and D

1 (1h)
95% CI 0.01 (-0.13, 0.15) 0.06 (-0.08, 0.21) 0.08 (0.06, 0.23) 0.05 (-0.09, 0.20 0.07 (-0.07, 0.22) 0.02 (-0.12, 0.16)
P 1.000 1.0000 0.7196 1.0000 1.0000 1.0000
2 (2H)
95% CI -0.05 (-0.28, 0.180 0.17 (-0.06, 0.05) 0.18 (-0.05, 0.41) 0.22 (-0.00, 0.45) 0.23 (0.00, 0.46) 0.01 (-0.22, 0.24)
P 1.0000 0.7909 0.2575 0.0588 0.0459 1.0000
3 (4H)
95% CI -0.25 (-0.59, 0.009) 0.21 (-0.12, 0.55) 0.15 (-0.18, 0.49) 0.46 (0.13, 0.80) 0.40 (0.07, 0.74) -0.06 (-0.40, 0.77)
P 0.2975 0.5612 1.0000 0.0017 0.009 1.0000
4 (8h)
95% CI -0.47 (-0.98, 0.04) 0.25 (-0.26, 0.76) 0.27 (-0.26, 0.78) 0.72 (0.22, 1.23) 0.74 (0.23, 1.25) 0.02 (0.40, 0.52)
P 0.0877 1.0000 1.0000 0.0011 0.0008 1.0000
5 (12H)
95% CI -0.55 (1.24, 0.14) 0.34 (-0.35, 1.03) 0.40 (-0.29, 1.09) 0.89 (0.21, 1.58 0.96 (0.27, 1.64) 0.06 (-0.62, 0.75)
P 0.2045 1.0000 0.7363 0.0034 0.0014 1.0000
6 (24h)
95%CI -0.08 (-2.79, 0.33) -0.22 (-1.53, 1.10) 0.21 (-1.11, 1.53) 0.77 (-1.54, 2.07) 1.19 (0.11, 2.50) 0.43 (-0.88, 1.73)
P 0.1529 1.0000 1.0000 0.7672 0.0966
7 (48)
95%CI -0.00 (-1.00, 0.40) 0.20 (-0.81, 1.20) 0.52 (-0.49, 1.53) 0.79 (-0.20, 1.79) 1.1790.12, 2.12) 0.32 (-0.68, 1.32)
P 0.6911 1.0000 1.0000 0.2321 0.0187 1.0000

1 The pruritus scores at 12h for groups A and C were equivalent to the scores of group B and D at 48h.

receptor affinity, thus, explaining its analgesic potency of 5 to

4. Discussion
Postoperative pain is most marked after operation in the
upper and lower abdomen and, if treated appropriately or
adequately, it may result in low incidence of post-operative
complication and morbidity. [10]
This study has shown that there was no significant
difference in analgesia among the four groups. The study was
designed to compare the efficacy of fentanyl and sufentanil
as a postoperative analgesic drug. It has now been established
that postoperative analgesia, besides providing relief and
comfort to patients, can also facilitate accelerated recovery,
an approach labelled as “postoperative rehabilitation”. An
ideal analgesicis sought to provide relief of pain without
change in consciousness, early return of normal function,
having localized effect and be devoid of systemic side
effects.
Fentanyl is a µreceptor agonist which belongs to the
phenylpiperidine group and exhibits lipophilic properties.
Sufentanil is a newer thienyl analogue of fentanyl, and also
acts a µreceptor agonist. Sufentanil displays a higher opioid
10times greater than that of fentanyl. [12, 13]
Demographical groups were comparable with
predominance.
In this study, 240 patients aged 18 to 65 years old, of both
genders were selected, and their ASA grade, height, physical
status, weight and age were arranged in comparable groups.
Itching episodes, Ramsay sedation score, the score vomiting,
VAS score and score nausea were found to be similar in the
four groups.
Pressing times of group B after 2h, 4h, 8h, 12h and 24h
respectively compared with the values in group D showed a
significant decrease in group D at 4h, 8h and 12h. Group C
also showed a significant decrease postoperatively. (table 6)
Fentanyl and sufentanil can achieve good analgesic effect,
and, high-dose sufentanil is superior to low dose for
providing pain relief.
The results of the 4 groups are presented in table 5. The
VAS scores in Group C were considerably lower after 1h and
2 h, while in group D, the scores at 2h, 4 h and 8h were lower
than that of group A. When compared with group B, VAS
 Journal of Anesthesiology 2015; 3(6): 25-29
scores of group D at 4h and 8h were also found to be lower.
Patients in the high-dose sufentanil group (C, D) have
reported higher analgesic effects than patients on fentanyl
(A), while the lower-dose sufentanil (B), has shown to be less
effective to control the pain than high-dose group D. [14, 15,
16, 17]
The VAS activity score after 1h and 2h for Group C, and the
VAS score for Group D at 2h post-op displayed lesser values
when both were compared with group A. These scores helped
to validate the superior analgesic properties at high dosages of
sufentanil (C, D) when compared with fentanyl (A).
There were also significant differences (P=0, 05) in the
occurrence of pruritus:
Comparison of the pruritus scores in the 4 groups revealed
that after 12h, group C had a lower score than group B, C and
D were all significantly decreased. This observation showed
that the occurrence of pruritus at the 3 doses of sufentanil
was less frequent than in the fentanyl patients of Group A.
5. Conclusion
From the results of our study, we can appraise the crucial
role of opioids in the management of acute moderate to
severe pain. Patient-controlled analgesic administration
resulted in a higher degree of satisfaction than nurse-
managed approaches. Sufentanil use for analgesia in surgical
patients was shown to have superior effect to fentanyl, with
lesser extent of adverse reactions to light. Based on the
finding that low-dose sufentanil (B) yields less adequate
analgesia compared to high dosages (C, D), the concentration
of persistent postoperative analgesia sufentanil should reach
0.02µg / (kg ml), the flow rate of 2ml / h.
Conflict of Interest
The authors declare that there is no conflict of interest with
any financial organization or corporation or individual that
can inappropriately influence this work.
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